Ultrasound enhanced central venous catheter

ABSTRACT

A central venous catheter comprises an ultrasound assembly. In one arrangement, the radiating member is used to remove a blockage from the central venous catheter. In another arrangement, inserting an ultrasound assembly into a central venous catheter. The ultrasound assembly comprises an ultrasound radiating member mounted on an elongate support structure. The method further comprises positioning the ultrasound assembly within the central venous catheter such that the ultrasound radiating member is adjacent to a deposited material formed on a portion of the central venous catheter. The method further comprises supplying an electrical current to the ultrasound radiating member to expose the deposited material to ultrasonic energy. The method further comprises passing a therapeutic compound through the central venous catheter to expose the deposited material to the therapeutic compound simultaneously with ultrasonic energy.

PRIORITY CLAIM

This is a continuation of International Application PCT/US2004/012362(filed 22 Apr. 2004), which claims the benefit of U.S. ProvisionalApplication No. 60/464,673 (filed 22 Apr. 2003), the entire disclosureof which is hereby incorporated in its entirety by reference herein.

FIELD OF THE INVENTION

The present invention relates generally to use of an ultrasound assemblywith a central venous catheter, and more specifically to usingultrasonic energy to enhance the efficacy of a central venous catheter.

BACKGROUND OF THE INVENTION

The term “central venous catheter” or “CVC,” refers generally, inaddition to its ordinary meaning, to a catheter that has been insertedinto a vein of the vascular system. Although CVCs have many variedapplications, CVCs are frequently used when a patent requires frequentor continuous injections of medications or fluids for nutritionalsupport. Common CVC applications include, but are not limited to,chemotherapy, long-term intravenous antibiotics, long-term painmedications, long-term intravenous nutrition, frequent blood draws,dialysis, and plasmapheresis. Therefore, a CVC can be used to deliverfluids to, or extract fluids from, the cardiovascular system.

In a wide variety of medical applications, the tip of a CVC is advancedinto the superior vena cava (“SVC”) from an upper extremity jugular veinor subclavian vein. Other approaches and deployment locations can beused in other applications. CVCs are used in a wide variety ofapplications; one common application is in the provision of atherapeutic compound into a patient's vascular system.

When a CVC is used for an extended period, blockages can form within theCVC, or can form outside the CVC in the vein between the CVC and theblood vessel wall. For example, a blockage inside the CVC can be causedby drug precipitate or thrombus. Additionally, platelet aggregation orfibrin deposition can completely encase the surface of the CVC, or canform a sac around the distal end of the CVC. Conventionally, suchblockages were removed, if at all, either by removing andreplacing/cleaning the CVC or while the CVC is in place passing aclot-dissolving compound through the CVC to dissolve the blockage.However, removing the CVC catheter is generally not desirable andintroducing a large quantity of clot-dissolving compounds into thevascular system can have negative side effects.

SUMMARY OF THE INVENTION

Therefore, a device capable of removing blockages or other materialsfrom within or around a CVC, without removing the CVC and/or causing thenegative side effects associated with the introduction of largequantities of clot-dissolving compounds into the vascular system, hasbeen developed. In addition, an improved CVC that is capable of beingoutfitted with an ultrasound assembly is also provided.

Accordingly, one embodiment of the present invention comprises anelongate central venous catheter. The elongate central venous catheterhaving a distal region configured for insertion into a patient'svasculature. The elongate central venous catheter also has a fluiddelivery lumen configured to allow a fluid to be delivered through thecentral venous catheter to the patient's vasculature. The apparatusfurther comprises an ultrasound assembly configured to be positionedadjacent to the central venous catheter distal region. The apparatusfurther comprises a temperature sensor configured to measure atemperature in a region adjacent to the ultrasound assembly.

According to one embodiment of the present invention, a method forremoving a blockage from a central venous catheter comprises insertingan ultrasound assembly into a central venous catheter. The ultrasoundassembly comprises an ultrasound radiating member mounted on an elongatesupport structure. The method further comprises positioning theultrasound assembly within the central venous catheter such that theultrasound radiating member is adjacent to a deposited material formedon a portion of the central venous catheter. The method furthercomprises supplying an electrical current to the ultrasound radiatingmember to expose the deposited material to ultrasonic energy. The methodfurther comprises passing a blockage removal compound through thecentral venous catheter to expose the deposited material to the blockageremoval compound simultaneously with ultrasonic energy.

According to another embodiment of the present invention, a methodcomprises exposing a deposited material formed on a central venouscatheter to ultrasonic energy while the central venous catheter ispositioned in a patient and exposing the deposited material to ablockage removal compound while the central venous catheter ispositioned in a patient.

According to another embodiment of the present invention, a method forremoving a deposited material from a catheter comprises supplying ablockage removal compound to the deposited material. The method furthercomprises exposing the deposited material to ultrasonic energy generatedby an ultrasound radiating member positioned within the catheter. Themethod further comprises measuring a temperature on the catheter toprovide an indication of progression of the removal of the depositedmaterial from the catheter.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the CVCs disclosed herein, and exemplarymethods for using said CVCs are illustrated in the accompanyingdrawings, which are for illustrative purposes only. The drawingscomprise the following figures, in which like numerals indicate likeparts.

FIG. 1 is a perspective view of an exemplary embodiment of a distal endof a CVC structure having a fibrin sleeve formed thereover.

FIG. 2 is a perspective view of an exemplary embodiment of a distal endof a CVC structure having a intraluminal thrombus or clot formedtherein.

FIG. 3 is a cross-sectional view of a CVC disposed within a patient'svasculature, wherein an ultrasound assembly is positioned within theCVC.

FIG. 4 is a side view of the ultrasound assembly positioned within theCVC of FIG. 3.

FIG. 5A is a cross-sectional view of a CVC having an embedded ultrasoundradiating member.

FIG. 5B is a cross-sectional view of the CVC of FIG. 5A, taken alongline 5B-5B.

FIG. 6 is a perspective illustration of a CVC elongate body having asuture wing in the catheter proximal region.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

As described above, material can be deposited in and around a CVC duringextended use. Such deposition can adversely affect operation of the CVC,making it difficult or impossible to deliver therapeutic compounds orother materials through the CVC to the patient's vasculature. Therefore,improvements have been developed to mitigate the adverse affectsassociated with material deposition in or around a CVC. Exemplaryembodiments of these improvements are disclosed herein.

A wide variety of CVC structures exist, and the improvements describedherein are not intended to be limited to a particular CVC structure.Rather, the improvements are described in connection with a generic CVCstructure, with the understanding that these improvements are notlimited to use with that particular CVC structure. For example, CVCs canbe configured with multiple lumens, rather than a single central lumen.For example, in one embodiment, a CVC catheter has been one lumen andfive lumens. Multiple lumens can be used for introducing and withdrawingfluids and devices, such as a guidewire. Likewise, the improvementsdisclosed herein can be used with catheters other than CVC catheters,such as with catheters configured to be inserted into other regions ofthe vascular system.

Accordingly, the term “central venous catheter” refers generally, inaddition to its ordinary meaning, to a catheter that has been insertedinto a vein of the vascular system. In a wide variety of medicalapplications, the tip of a CVC is advanced into the superior vena cava(“SVC”) from an upper extremity jugular vein or subclavian vein. Otherapproaches and deployment locations can be used in other applications.CVCs are used in a wide variety of applications; one common applicationis in the provision of a therapeutic compound into a patient's vascularsystem.

As used herein, the term “therapeutic compound” refers broadly, withoutlimitation, to a drug, medicament, dissolution compound, geneticmaterial or any other substance capable of effecting physiologicalfunctions. Additionally, any mixture comprising any such substances isencompassed within this definition of “therapeutic compound”, as well asany substance falling within the ordinary meaning of these terms.

As used herein, the term “ultrasound energy” is a broad term and is usedin its ordinary sense and means, without limitation, mechanical energytransferred through pressure or compression waves with a frequencygreater than about 20 kHz. In one embodiment, the waves of theultrasound energy have a frequency between about 500 kHz and 20 MHz andin another embodiment between about 1 MHz and 3 MHz. In yet anotherembodiment, the waves of the ultrasound energy have a frequency of about3 MHz.

As used herein, the term “catheter” is a broad term and is used in itsordinary sense and means, without limitation, an elongate flexible tubeconfigured to be inserted into the body of a patient, such as, forexample, a body cavity, duct or vessel.

A distal region of a generic CVC structure is illustrated in FIGS. 1 and2. As illustrated, a generic CVC comprises a flexible, elongate body 100that forms a central lumen 110. The elongate body 100 has an outersurface 120, and is dimensioned to facilitate its passage through theperipheral vascular system. Generally, suitable materials and dimensionsfor the CVC can be selected readily based on the natural and anatomicaldimensions of the particular treatment site and percutaneous accesssite. Examples of suitable CVC materials include, but are not limitedto, extruded polytetrafluoroethylene (“PTFE”), polyethylenes (“PE”),polyamides and other similar materials. In CVCs configured for long termimplantation, soft materials such as urethanes and silicones can be usedto form the catheter body. Additionally, a CVC optionally includes acoating, such as a silver coating, to reduce the likelihood ofinfection.

In certain embodiments, the proximal region of the CVC is reinforced bybraiding, mesh or other internal or external structures to provideincreased kink resistance and pushability, thereby facilitating passageof the CVC through the patient's vasculature. In other embodiments, theCVC body can be reinforced by including a stylet in the CVC body, whichserves to maintain rigidity of the CVC during passage through thepatient's vasculature. In such embodiments, a thin, elongate wire can beused as a stylet.

In one embodiment, a CVC has an outer diameter between approximately 6French and approximately 14 French.

A CVC optionally includes a suture wing or cuff in the catheter proximalregion, which can be used to attach the proximal end of the CVC to thepatient. For example, FIG. 6 illustrates a CVC elongate body 100 havinga suture wing 190 in the catheter proximal region. The suture wing 190can be constructed of a material suitable for attachment to a patient'sbody. In other embodiments, a cuff that may be made out of a materialsuch as Dacron can be used. As illustrated, the CVC optionally includesa proximal hub 195 that can be used to supply fluid, such as atherapeutic compound, through a CVC lumen.

As described above, material often deposits in and around a CVC that hasbeen positioned within a patent's vasculature for an extended period oftime. Such blockages can be caused by therapeutic compound precipitate,platelet aggregation, or fibrin deposition. For example, FIG. 1illustrates the formation of a fibrin sleeve 130 at the distal region ofthe CVC, and FIG. 2 illustrates the formation of a thrombus or clot 140within the CVC central lumen 110. Either of these conditions canadversely affect the operation of the CVC, making it difficult orimpossible to pass therapeutic compounds or other materials through theCVC and into the patient's vasculature.

The blockages described above, whether formed inside or outside the CVC,often become coated with a protein substance that provides a shield forbacteria. This protein “shield” makes it difficult to treat bacterialgrowth within the blockage using antibiotics. Therefore, because of thebacteria-resistant shield, bacterial growth within the blockage canproliferate, increase the size of the blockage, and cause infection.This process is a significant contributing factor to upper extremitydeep vein thrombosis (“DVT”).

An obstruction within a CVC can be cleaned while in the patient by usinga brush and a small amount of a therapeutic compound, such as a lyticsolution. However, it is difficult or impossible to clean the outersurface of a CVC using a brush. In an exemplary embodiment, ultrasonicenergy is used to clean one or more portions of a CVC, such as thecentral lumen 110, the elongate body outer surface 120, or both.Preferably, the ultrasonic energy is used in combination with a blockageremoval compound to clean the one or more portions of the CVC. In suchembodiments, the ultrasonic energy is preferably configured to enhancethe therapeutic effects and/or delivery of the blockage removalcompound. For example, the ultrasonic energy can be used to penetratethe protein shield that often covers an occlusion, thereby allowing ablockage removal compound, such as a solution containing anantibacterial agent and/or a thrombus removing compound (e.g., Heparin,Uronkinase, Streptokinase, TPA and other thrombolytics or anti-thrombusagents) to be delivered directly to the occlusion. The ultrasonic energycan be delivered independent of, or simultaneously with, the blockageremoval compound. In another use of the system disclosed herein, a CVCis exposed to ultrasonic energy periodically to reduce or preventaccumulation of protein thereon. Preferably, in these embodiments, theultrasound and/or the blockage removal compound applied while thecentral venous catheter is positioned in a patient.

One system for using ultrasonic energy to clean a CVC is illustrated inFIG. 3. FIG. 3 is a cross-sectional illustration of the elongate body100 of a CVC that has been positioned within a patient's vasculature150. As illustrated, this system can be used to clean deposited materialfrom within the CVC outer surface 120 (such as a fibrin sleeve 130), orfrom the CVC inner lumen 110 (such as a thrombus or clot 140), or both.Similarly, this system can be used to clean deposited material from thedistal end of the CVC, or from an intermediate position on the CVC.

Still referring to FIG. 3, to expose the deposited material toultrasonic energy, an ultrasound assembly 160 is inserted into, andpassed through the elongate body 100. The ultrasound assembly 160, aside view of which is illustrated in FIG. 4, comprises an ultrasoundradiating member 165 positioned at the distal end of an elongate supportmember 167. In an exemplary embodiment, the ultrasound radiating membercomprises lead zirconate titanate (“PZT”), although other materialscapable of generating mechanical vibrations when exposed to electronicsignals can also be used. Although the ultrasound assembly 160illustrated in FIG. 4 comprises one ultrasound radiating member 165, ina modified embodiment, multiple ultrasound radiating members arepositioned along the elongate support member 167. The multipleultrasound radiating members can be controlled independently of eachother. In another modified embodiment, the ultrasound radiating memberis mechanically connected to an ultrasound oscillator positioned at theproximal end of the CVC, outside the patient's body; additionalinformation regarding this configuration is provided U.S. Pat. No.6,524,251, issued on 25 Feb. 2003, and entitled “Ultrasonic Device forTissue Ablation and Sheath for Use Therewith.”

Additional information regarding controlling a plurality of ultrasoundradiating members are provided in U.S. Patent Application Publication US2004/0024347 A1, published on 5 Feb. 2004 and entitled “Catheter withMultiple Ultrasound Radiating Members,” the entire disclosure of whichis hereby incorporated herein by reference herein. Additionalinformation regarding mounting one or more ultrasound radiating memberson an elongate support structure are provided in U.S. patent applicationSer. No. 10/751,843, filed on 5 Jan. 2004 and entitled “UltrasonicCatheter with Axial Energy Field,” the entire disclosure of which ishereby incorporated by reference herein.

A temperature sensor 169 is optionally positioned in a distal region ofthe elongate support member 169. In other embodiments, the temperaturesensor 169 is positioned directly on the ultrasound radiating member165. In such embodiments, the ultrasound radiating member 165, andoptionally the temperature sensor 169, are electrically connected tocontrol circuitry at a proximal end of the ultrasound assembly 160. Thetemperature sensor can be used to monitor and control the progression ofthe cleaning procedure. In particular, when removing a blockage fromwithin or around a CVC, a decrease in the temperature at the treatmentsite can indicate that the blockage has been at least partially removedor dissolved, and that flow has been at least partially reestablished atthe treatment site. In addition, the temperature sensor may be used todetermine that the radiating member is positioned 165 within theblockage. Additional information regarding using temperaturemeasurements to monitor the progression of an ultrasound-enhancedtreatment are provided in U.S. Patent Application Publication2003/0220568 A1, published on 27 Nov. 2003 and entitled “Blood FlowReestablishment Determination,” as well as in U.S. Provisional Pat.Applications Nos. 60/540,900 (filed 29 Jan. 2004) and 60/540,703 (filed30 Jan. 2004); the entire disclosure of these three applications ishereby incorporated by reference herein.

As described above, the ultrasound assembly 160 is passed through theCVC to a point that the ultrasound radiating member 165 is positionedadjacent to a blockage. The blockage is located either within the CVCelongate body 100, or outside the CVC elongate body 100. When theultrasound radiating member 165 is activated via the control circuitry,ultrasonic vibrations are generated, thereby exposing the blockage toultrasonic energy 170. The blockage can also optionally be exposed to ablockage removal compound to assist in breaking down or dissolving theblockage, such as a thrombolytic solution or an antibacterial solution.The blockage removal compound can be delivered through the CVC itself,or can be independently supplied to the treatment site by, for example,a secondary delivery catheter or a delivery lumen formed integrally withthe central venous catheter. In an exemplary embodiment, the ultrasonicenergy enhances the effect of the blockage removal compound, asdescribed previously.

In a modified embodiment, the CVC is configured to facilitate thedelivery of ultrasonic energy to blockages that form on or within theelongate body. For example, in one embodiment, the elongate body, oroptionally only a distal region of the elongate body, is formed from amaterial that is substantially transparent to ultrasonic energy. Thisconfiguration advantageously allows ultrasonic energy generated by anultrasound radiating member positioned within the central lumen 110 topass through the elongate body 100 and be absorbed by a blockage outsidethe CVC.

The ultrasound radiating member 165 need not be positioned within theCVC central lumen 110. For example, the ultrasound assembly can bepassed along the outer surface 120 of the CVC in a region 180 (see FIG.3) between the patient's vasculature 150 and the CVC. In anotherembodiment, the ultrasound radiating member 150 is embedded within thewalls of the CVC, as illustrated in FIG. 5A and 5B.

As shown in FIGS. 5A and 5B, a modified ultrasound catheter 1100, suchas a CVC, generally comprises a multi-component tubular body 1102 havinga proximal region (not shown) and a distal region 1106. Suitablematerials and dimensions for the ultrasound catheter 1100 can beselected based on the natural and anatomical dimensions of the treatmentsite and of the percutaneous access site.

The elongate, flexible tubular body 1102 comprises an outer sheath 1130that is positioned upon an inner core 1110. In an exemplary embodiment,the outer sheath 1130 comprises extruded PEBAX, PTFE, PEEK, PE,polymides, braided polymides and/or other similar materials that aresubstantially transparent to ultrasonic energy. In an exemplaryembodiment, the inner core 1110 comprises polymide or a similar materialwhich, in some embodiments, can be braided to increase the flexibilityof the tubular body 1102. The inner core 1110 at least partially definesa delivery lumen 1112 that extends longitudinally along the catheter1100. The delivery lumen 1112 includes a distal exit port 1114. At aproximal end of the catheter 1100, the delivery lumen 1112 optionallyincludes a Luer fitting to facilitate the passage of a fluidtherethrough.

Still referring to the exemplary embodiment illustrated in FIGS. 5A and5B, the tubular body distal region 1106 includes the ultrasoundradiating member 1124. In a modified embodiment, the ultrasonic energycan be generated by an ultrasound radiating member that is remote fromthe treatment site; in such embodiments the ultrasonic energy can betransmitted via, for example, a wire to the treatment site, as describedabove.

As illustrated in FIGS. 5A and 5B, the ultrasound radiating member 1124is configured as a hollow cylinder. As such, the inner core 1110 extendsthrough the ultrasound radiating member 1124. The ultrasound radiatingmember 1124 is secured to the inner core 1110 in a suitable manner, suchas with an adhesive. A potting material is optionally used to furthersecure the mounting of the ultrasound radiating member 1124 along theinner core 1110.

In other embodiments, the ultrasound radiating member 1124 is configuredwith a different shape. For example, the ultrasound radiating member canbe configured as a solid rod, a disk, a solid rectangle, a curvedelement (such as a split cylinder or a curved rectangular element), or athin block. In such embodiments. the ultrasound radiating members areconfigured with dimensions that allow them to be embedded within thewalls of the CVC, as the ultrasound radiating member 1124 illustrated inFIGS. 5A and 5B is embedded in the CVC wall. In other embodiments,wherein the CVC includes a plurality of lumens formed within thecatheter, the ultrasound radiating members can be embedded in thecatheter walls between the lumens. Because relatively soft materials areoften used to form the CVC body, as described above, the catheter wallscan be configured with a relatively large thickness, thereby providingample space to support one or more embedded ultrasound radiatingmembers. Particular characteristics of the ultrasound radiating membercan be optimized with routine experimentation based on the particularphysical configuration of the CVC body, including the CVC bodymaterials, dimensions, and shape.

Still further, the ultrasound radiating member can comprise a pluralityof smaller ultrasound radiating members. However, the illustratedarrangement advantageously provides for enhanced cooling of theultrasound radiating member 1124. For example, in embodiments wherein atherapeutic compound is delivered through the delivery lumen 1112, thetherapeutic compound advantageously serves as a heat sink for removingheat generated by the ultrasound radiating member 1124. In anotherembodiment, a return path can be formed in the region 1138 between theouter sheath 1130 and the inner core 1110, such that coolant from acoolant system can be directed through the region 1138.

In a modified embodiment, the CVC is configured to caused the ultrasonicenergy generated by the ultrasound radiating member to radiate outwardfrom the CVC or inward toward the central lumen. This can beaccomplished, for example, by positioning a chamber of high ultrasonicimpedance material on the opposite side of the ultrasound radiatingmember from where the ultrasonic energy is to be directed. Thismodification can be made with a variety of different ultrasoundradiating member configurations, including hollow cylindricalconfigurations and rectangular configurations. Additional informationregarding the use of a backing to direct ultrasonic energy is providedis U.S. Pat. No. 6,676,626, issued on 13 Jan. 2004, and entitled“Ultrasound Assembly with Increased Efficacy,” and in U.S. Pat. No.6,582,392, issued on 24 Jun. 2003, and entitled “Ultrasound Assembly forUse with a Catheter”, which are hereby incorporated by reference hereinin their entirety.

In an exemplary embodiment, the ultrasound radiating member 1124 isselected to produce ultrasonic energy in a frequency range that is wellsuited for removal of deposited material from the catheter 1100.Suitable frequencies of ultrasonic energy include, but are not limitedto, from about 20 kHz to about 20 MHz. In one embodiment, the frequencyis between about 500 kHz and 20 MHz, and in another embodiment thefrequency is between about 1 MHz and about 3 MHz. In yet anotherembodiment, the ultrasonic energy has a frequency of about 3 MHz.

As described above, ultrasonic energy is generated from electrical powersupplied to the ultrasound radiating member 1124. The electrical powercan be supplied through a pair wires 1126, 1128 that extend through thetubular body 1102. In an exemplary embodiment, the electrical wires1126, 1128 are secured to the inner core 1110, lay along the inner core1110, and/or extend freely in the region 1138 between the inner core1110 and the outer sheath 1130. In the illustrated arrangement, thefirst wire 1126 is connected to the hollow center of the ultrasoundradiating member 1124, while the second wire 1128 is connected to theouter periphery of the ultrasound radiating member 1124.

With continued reference to the exemplary embodiment illustrated in FIG.5B, the catheter 1100 includes at least one temperature sensor 1136along the tubular body distal region 1106. The temperature sensor 1136is located on or near the ultrasound radiating element 1124. Suitabletemperature sensors include but are not limited to, diodes, thermistors,thermocouples, resistance temperature detectors (“RTDs”), and fiberoptic temperature sensors that used thermalchromic liquid crystals. Insuch embodiments, the temperature sensor is operatively connected tocontrol circuitry through a control wire that extends through thetubular body 1102.

In other embodiments, a vibrational element is embedded in the wall of aCVC. In such embodiments, the vibrational element comprises a metalliccompound that can be vibrated by application of an oscillatingelectromagnetic field from outside the body. For example, anexternally-applied electromagnetic field can be used to vibrate aferro-metallic ring or cylinder embedded in the wall of the catheter1100. In such embodiments, wires and electrodes used to supply power toan ultrasound radiating member can be eliminated. In certainembodiments, the vibrational element embedded is configured to vibrateupon application of an externally-applied oscillating electric field, ormagnetic field, or upon application of externally-applied ultrasonicenergy.

Scope of the Invention

For purposes of describing the invention and the advantages achievedover the prior art, certain features, objects and advantages of theinvention have been set forth herein. Not necessarily all such features,objects or advantages may be used or achieved in accordance with aparticular embodiment of the invention. Thus, for example, the inventionmay be embodied or carried out in a manner that achieves or optimizesone advantage or group of advantages as taught herein withoutnecessarily achieving other objects or advantages as may be taught orsuggested herein. In addition, various methods and procedures have beendescribed above. It should be understood that those methods andprocedures should not be limited to the sequence described but may beperformed in different orders and that not necessarily all of the stepsof a method or procedure needs to be performed. Furthermore, the presentinvention is not limited to any particular disclosed embodiment, but islimited only by the claims set forth below.

1. An apparatus comprising: an elongate central venous catheter having adistal region configured for insertion into a patient's vasculature, anda fluid delivery lumen configured to allow a fluid to be deliveredthrough the central venous catheter to the patient's vasculature; anultrasound assembly configured to be positioned adjacent to the centralvenous catheter distal region; and a temperature sensor configured tomeasure a temperature in a region adjacent to the ultrasound assembly.2. The apparatus of claim 1, wherein the ultrasound assembly comprisesan ultrasound radiating member mounted on an elongate support structureconfigured to be passed through the central venous catheter.
 3. Theapparatus of claim 1, wherein the ultrasound assembly comprises anultrasound radiating member mounted on the central venous catheter. 4.The apparatus of claim 1, wherein the ultrasound assembly comprises aplurality of ultrasound radiating members.
 5. The apparatus of claim 1,wherein the temperature sensor is a thermocouple.
 6. The apparatus ofclaim 1, wherein central venous catheter has an outer diameter betweenapproximately 6 French and approximately 14 French.
 7. A method forremoving a blockage from a central venous catheter comprising: insertingan ultrasound assembly into a central venous catheter, the ultrasoundassembly comprising an ultrasound radiating member mounted on anelongate support structure; positioning the ultrasound assembly withinthe central venous catheter such that the ultrasound radiating member isadjacent to a deposited material formed on a portion of the centralvenous catheter; supplying an electrical current to the ultrasoundradiating member to expose the deposited material to ultrasonic energy;and passing a blockage removal compound through the central venouscatheter to expose the deposited material to the blockage removalcompound simultaneously with ultrasonic energy.
 8. The method of claim7, wherein the ultrasound assembly comprises a plurality of ultrasoundradiating members.
 9. The method of claim 7, wherein the ultrasoundassembly comprises a plurality of ultrasound radiating members, andwherein the plurality of ultrasound radiating members are individuallycontrollable.
 10. The method of claim 7, further comprising measuring atemperature in a region adjacent to the ultrasound radiating member. 11.The method of claim 7, further comprising: measuring a temperature in aregion adjacent to the ultrasound radiating member; and adjusting theelectrical current supplied to the ultrasound radiating member based onthe measured temperature.
 12. The method of claim 7, wherein theblockage removal compound is also passed through the central venouscatheter before ultrasonic energy is supplied to the deposited material.13. A method comprising exposing a deposited material formed on acentral venous catheter to ultrasonic energy while the central venouscatheter is positioned in a patient and exposing the deposited materialformed on the central venous catheter to a blockage removal compoundwhile the central venous catheter is positioned in a patient.
 14. Themethod of claim 13, wherein the blockage removal compound comprises anantibacterial solution.
 15. The method of claim 13, wherein theultrasonic energy has a frequency between about 20 kHz and about 20 MHz.16. The method of claim 13, the blockage removal compound comprises athrombus removing agent.
 17. The method of claim 13, wherein theblockage removal compound is also delivered to the deposited materialbefore ultrasonic energy is supplied to the deposited material.
 18. Themethod of claim 13, wherein the ultrasonic energy is also delivered tothe deposited material after termination of the delivery of blockageremoval compound to the deposited material.
 19. The method of claim 13,wherein the ultrasonic energy is delivered from an ultrasound assemblypositioned within a central lumen of the central venous catheter. 20.The method of claim 13, wherein the ultrasonic energy is delivered froman ultrasound assembly positioned within a central lumen of the centralvenous catheter, and wherein the ultrasound assembly comprises anultrasound radiating member mounted on an elongate support structure.21. The method of claim 13, wherein the ultrasonic energy is deliveredfrom an ultrasound assembly positioned within a central lumen of thecentral venous catheter, and wherein the ultrasound assembly comprises aplurality of ultrasound radiating members mounted on an elongate supportstructure.
 22. The method of claim 13, further comprising measuring atemperature adjacent to the deposited material.
 23. The method of claim13, further comprising: measuring a temperature adjacent to thedeposited material; and adjusting the amount of ultrasonic energydelivered to the deposited material based on the measured temperature.24. The method of claim 13, wherein the ultrasonic energy is deliveredfrom an ultrasound radiating member embedded in an elongate body of thecentral venous catheter.
 25. The method of claim 13, wherein theblockage removal compound is delivered to the deposited material throughthe central venous catheter.
 26. The method of claim 13, wherein theblockage removal compound is delivered to the deposited material througha delivery lumen formed integrally with the central venous catheter. 27.A method for removing a deposited material from a catheter comprising:supplying a therapeutic compound to the deposited material; exposing thedeposited material to ultrasonic energy generated by an ultrasoundradiating member positioned within the catheter; and measuring atemperature on the catheter to provide an indication of progression ofthe removal of the deposited material from the catheter.
 28. The methodof claim 27, wherein the therapeutic compound comprises an antibacterialsolution.
 29. The method of claim 27, wherein the deposited material isexposed to ultrasonic energy and therapeutic compound simultaneously.30. The method of claim 27, wherein the catheter comprises a centralvenous catheter.
 31. The method of claim 27, wherein the ultrasoundradiating member is positioned within a central lumen of the catheter.32. The method of claim 27, wherein the ultrasound radiating member isembedded within an elongate body of the catheter.
 33. The method ofclaim 27, further comprising adjusting the amount of ultrasonic energydelivered to the deposited material based on the measured temperature.